SUDDEN CARDIACDEATHINYOUNG ATHLETESThe Basic Facts onSudden Cardiac Deathin Young Athletes

SUDDEN CARDIAC DEATH IN YOUNG ATHLETES

Sudden death in young athletesbetween the ages of 10and 19 is very rare.

What, if anything, can bedone to prevent this kind oftragedy?

What is sudden cardiac deathin the young athlete?

Sudden cardiac death is theresult of an unexpected failure of properheart function, usually (about 60% of thetime) during or immediately after exercisewithout trauma. Since the heart stopspumping adequately, the athlete quicklycollapses, loses consciousness, andultimately dies unless normal heart rhythmis restored using an automated externaldefibrillator (AED).

How common is sudden death in youngathletes?

Sudden cardiac death in young athletes isvery rare. About 100 such deaths arereported in the United States per year.The chance of sudden death occurringto any individual high school athlete isabout one in 200,000 per year.

Sudden cardiac death is morecommon: in males than in females;in football and basketball than inother sports; and in African-Americans thanin other races and ethnic groups.

What are the most common causes?

Research suggests that the main cause is aloss of proper heart rhythm, causing theheart to quiver instead of pumpingblood to the brain and body. This is calledventricular fibrillation (ven- TRICK-you-lar fib-roo-LAY-shun). The problem is usually causedby one of several cardiovascular abnormalitiesand electrical diseases of the heart that gounnoticed in healthy-appearing athletes.

The most common cause of sudden death inan athlete is hypertrophic cardiomyopathy(hi-per-TRO-fic CAR- dee-oh-my-OP-a-thee)also called HCM. HCM is a disease of the heart,with abnormal thickening of the heartmuscle, which can cause serious heart rhythmproblems and blockages to blood flow. Thisgenetic disease runs in families and usuallydevelops gradually over many years.

The second most likely cause is congenital(con-JEN-it-al) (i.e., present from birth)

abnormalities of the coronaryarteries. This means that theseblood vessels are connected to

the main blood vessel of theheart in an abnormal way. This

differs from blockages that mayoccur when people get older

(commonly called “coronary arterydisease,” which may lead to a heart

attack).

● Sudden Death in Athleteshttp://tinyurl.com/m2gjmvq

● Hypertrophic Cardiomyopathy Associationwww.4hcm.org

● American Heart Association www.heart.org

Collaborating Agencies:American Academy of Pediatrics New Jersey Chapter3836 Quakerbridge Road, Suite 108Hamilton, NJ 08619(p) 609-842-0014(f ) 609-842-0015www.aapnj.org

American Heart Association1 Union Street, Suite 301Robbinsville, NJ, 08691(p) 609-208-0020www.heart.org

New Jersey Department of EducationPO Box 500Trenton, NJ 08625-0500(p) 609-292-5935www.state.nj.us/education/

New Jersey Department of HealthP. O. Box 360Trenton, NJ 08625-0360(p) 609-292-7837www.state.nj.us/health

Lead Author: American Academy of Pediatrics, New Jersey ChapterWritten by: Initial draft by Sushma Raman Hebbar,MD & Stephen G. Rice, MD PhDAdditional Reviewers: NJ Department of Education,NJ Department of Health and Senior Services,American Heart Association/New Jersey Chapter, NJ Academy of Family Practice, Pediatric Cardiologists,New Jersey State School NursesRevised 2014: Nancy Curry, EdM; Christene DeWitt-Parker, MSN, CSN, RN; Lakota Kruse, MD, MPH; Susan Martz, EdM; Stephen G. Rice, MD; Jeffrey Rosenberg, MD, Louis Teichholz, MD; Perry Weinstock, MD

Website Resources

STATE OF NEW JERSEYDEPARTMENT OF EDUCATION

Other diseases of the heart that can lead tosudden death in young people include:● Myocarditis (my-oh-car-DIE-tis), an acute

inflammation of the heart muscle (usuallydue to a virus).

● Dilated cardiomyopathy, an enlargementof the heart for unknown reasons.

● Long QT syndrome and other electricalabnormalities of the heart which causeabnormal fast heart rhythms that can alsorun in families.

● Marfan syndrome, an inherited disorderthat affects heart valves, walls of majorarteries, eyes and the skeleton. It isgenerally seen in unusually tall athletes,especially if being tall is not common inother family members.

Are there warning signs to watch for?

In more than a third of these sudden cardiacdeaths, there were warning signs that werenot reported or taken seriously. Warningsigns are:● Fainting, a seizure or convulsions during

physical activity;● Fainting or a seizure from emotional

excitement, emotional distress or beingstartled;

● Dizziness or lightheadedness, especiallyduring exertion;

● Chest pains, at rest or during exertion;● Palpitations - awareness of the heart

beating unusually (skipping, irregular orextra beats) during athletics or during cooldown periods after athletic participation;

● Fatigue or tiring more quickly than peers; or● Being unable to keep up with friends due

to shortness of breath (labored breathing).

What are the current recommendationsfor screening young athletes?

New Jersey requires all school athletes to beexamined by their primary care physician(“medical home”) or school physician at leastonce per year. The New Jersey Department ofEducation requires use of the specific Prepar-ticipation Physical Examination Form (PPE).

This process begins with the parents andstudent-athletes answering questions aboutsymptoms during exercise (such as chestpain, dizziness, fainting, palpitations orshortness of breath); and questions aboutfamily health history.

The primary healthcare provider needs toknow if any family member died suddenlyduring physical activity or during a seizure.They also need to know if anyone in thefamily under the age of 50 had anunexplained sudden death such asdrowning or car accidents. This informationmust be provided annually for each exambecause it is so essential to identify those atrisk for sudden cardiac death.

The required physical exam includesmeasurement of blood pressure and a carefullistening examination of the heart, especiallyfor murmurs and rhythm abnormalities. Ifthere are no warning signs reported on thehealth history and no abnormalitiesdiscovered on exam, no further evaluation ortesting is recommended.

Are there options privately available toscreen for cardiac conditions?

Technology-based screening programsincluding a 12-lead electrocardiogram (ECG)and echocardiogram (ECHO) arenoninvasive and painless options parentsmay consider in addition to the required

PPE. However, these procedures may beexpensive and are not currently advised bythe American Academy of Pediatrics and theAmerican College of Cardiology unless thePPE reveals an indication for these tests. Inaddition to the expense, other limitations oftechnology-based tests include thepossibility of “false positives” which leads tounnecessary stress for the student andparent or guardian as well as unnecessaryrestriction from athletic participation.

The United States Department of Healthand Human Services offers risk assessmentoptions under the Surgeon General’s FamilyHistory Initiative available athttp://www.hhs.gov/familyhistory/index.html.

When should a student athlete see aheart specialist?

If the primary healthcare provider or schoolphysician has concerns, a referral to a childheart specialist, a pediatric cardiologist, isrecommended. This specialist will performa more thorough evaluation, including anelectrocardiogram (ECG), which is a graph ofthe electrical activity of the heart. Anechocardiogram, which is an ultrasound testto allow for direct visualization of the heartstructure, will likely also be done. Thespecialist may also order a treadmill exercisetest and a monitor to enable a longerrecording of the heart rhythm. None of thetesting is invasive or uncomfortable.

Can sudden cardiac death be preventedjust through proper screening?

A proper evaluation should find most, but notall, conditions that would cause sudden deathin the athlete. This is because some diseasesare difficult to uncover and may only developlater in life. Others can develop following a

normal screening evaluation, such as aninfection of the heart muscle from a virus.

This is why screening evaluations and areview of the family health history need tobe performed on a yearly basis by theathlete’s primary healthcare provider. Withproper screening and evaluation, most casescan be identified and prevented.

Why have an AED on site during sportingevents?

The only effective treatment for ventricularfibrillation is immediate use of an automatedexternal defibrillator (AED). An AED canrestore the heart back into a normal rhythm.An AED is also life-saving for ventricularfibrillation caused by a blow to the chest overthe heart (commotio cordis).

N.J.S.A. 18A:40-41a through c, known as“Janet’s Law,” requires that at any school-sponsored athletic event or team practice inNew Jersey public and nonpublic schoolsincluding any of grades K through 12, thefollowing must be available:● An AED in an unlocked location on school

property within a reasonable proximity tothe athletic field or gymnasium; and

● A team coach, licensed athletic trainer, orother designated staff member if there is nocoach or licensed athletic trainer present,certified in cardiopulmonary resuscitation(CPR) and the use of the AED; or

● A State-certified emergency servicesprovider or other certified first responder.

The American Academy of Pediatricsrecommends the AED should be placed incentral location that is accessible and ideallyno more than a 1 to 11/2 minute walk from anylocation and that a call is made to activate 911emergency system while the AED is beingretrieved.

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